Category: News (Page 1 of 2)

First study to use automated eye tracking to measure developmental outcomes of a nutrition trial

Eye tracking image

A paper just published in the Journal of Nutrition reports the first study to use automated eye tracking to measure infant developmental outcomes of a nutrition randomized trial. Effects of early nutrition on infant neurobehavioral development are typically measured using assessment of behavioral milestones, such as crawling and saying words. These assessments may not be highly sensitive to individual differences between children because there is a wide range of variability in the age children attain these milestones that is normal. Children’s scores on these types of measures during the first two years after birth are not strongly correlated with children’s later cognitive abilities.

Woman holding child for eye tracking

Measures of infant looking behavior may be more sensitive than measures based on milestone attainment. Infants’ eye gazes provide meaningful information about their cognitive processing. For example, an infant’s novelty preference, demonstrated by looking longer at a new picture compared to a previously seen picture, shows that the infant remembers the previously seen picture. Automated eye trackers detect the gaze focal point using an infrared light source and a set of cameras that capture the light reflected from the cornea. Recent advances have made this technology more feasible for use in low- and middle-income country settings. In this study, we used automated eye tracking to assess infant cognition in Malawi, in combination with commonly-used developmental assessments based on acquisition of behavioral milestones.

Eye tracking tool

The trial was designed to test whether feeding children eggs during the complementary feeding period improves growth and development and was funded by the Bill & Melinda Gates Foundation. The trial was led by Dr. Christine Stewart at the UC Davis Institute for Global Nutrition and Dr. Kenneth Maleta at the University of Malawi College of Medicine, with the developmental outcomes led by Dr. Elizabeth Prado at the UC Davis Institute for Global Nutrition in collaboration with Dr. Lisa Oakes at the UC Davis Center for Mind and Brain.

Mazira Project Logo

Eggs are nutrient-rich foods, which have been found to promote child growth in Ecuador. We enrolled 660 children age 6-9 months in rural Malawi and randomly assigned half of the children to the intervention group, who received seven eggs per week for the study child and seven eggs per week for the household, and half of the children to the control group, who did not receive eggs. After six months, we did not find any differences between the group who received eggs and the control group in attention, memory, language, motor, or personal-social skills, except a smaller percentage of children who received eggs had delayed fine motor skills, such as picking up small objects with their fingers. This study highlights that positive effects of egg interventions may be found in some contexts but not others, which should be considered when deciding whether to invest in programs to promote child egg consumption. Although we did not find effects of the intervention on the eye-tracking measures, we successfully obtained usable data from 60% of targeted children at age 6-9 months and 72% of targeted children at age 12-15 months. These success rates were obtained in the context of a full day of data collection and project activities for the participants, with as many as 25 participants assessed on any given day. This suggests that automated eye tracking is a new promising method to evaluate early child development in nutrition research in low- and middle-income countries.

Prado and Adu-Afarwuah launch new project examining long-term neural effects of early nutrition in Ghana

Dr. Prado and Dr. Adu-Afarwuah seated with collaborators

On February 27, 2020, Dr. Elizabeth Prado and Dr. Seth Adu-Afarwuah launched a new project in Ghana funded by $2,600,000 from the US National Institutes of Health. The project will be the first long-term follow-up in Africa of a randomized controlled trial in which the intervention group received a fortified food during most of the first 1000 days, from early pregnancy through 18 months of age.

Nutrients such as vitamins, minerals, and fatty acids are the building blocks for children’s healthy brain development. Much of the brain’s structure is laid during pregnancy and early childhood, when the brain and nervous system are developing very rapidly. Many pregnant women and young children do not eat sufficient nutrient-dense foods that contain these essential nutrients. If these nutrients are not available during critical periods when the brain is developing rapidly, there could be long-term effects on the structure and function of the brain and nervous system.

This new project will follow up children at 8-12 years of age whose mothers participated in a randomized controlled trial of nutritional supplementation when they were pregnant 10 years ago. The Packets of nutritional supplementsoriginal trial, the International Lipid-Based Nutrient Supplements (iLiNS) DYAD (mother-child dyad) trial, was led by Dr. Kay Dewey at UC Davis and Dr. Anna Lartey at the University of Ghana and was funded by the Bill & Melinda Gates Foundation. Pregnant women and children in the intervention group received lipid-based nutrient supplements (LNS), made from peanut paste, vegetable oil, and milk powder, with added vitamins and minerals. While small-quantity LNS provides only a small amount of calories per day (~118 kcal), it is packed with the vitamins, minerals, and fatty acids that are needed for children’s growth and development. In the control groups, women received a daily micronutrient capsule, similar to a pre-natal multi-vitamin, and the children did not receive any supplement.

When the children were 4-6 years of age, we found that children in the LNS group had fewer social-emotional difficulties compared to the control groups, especially those from home environments with low nurturing care and learning opportunities. The aims of the new project are to see whether we find the same pattern when the children are 8-12 years of age and to understand the neural mechanisms of protective effects of early nutrition on the development of social-emotional difficulties among children in Ghana. This will be the first randomized controlled trial to assess long-term Sagittal cross section of braineffects of early nutritional supplementation on nervous system development through combining methods to assess neurophysiology in both the central and autonomic nervous systems, including structural magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) and measures of autonomic nervous system (ANS) activity, including electrocardiogram and impedance cardiography. Co-investigators are Dr. Paul Hastings and Dr. Amanda Guyer at UC Davis, Dr. Adom Manu and Dr. Benjamin Amponsah at the University of Ghana, and Dr. Brietta Oaks at the University of Rhode Island.

Nutrition Programs Alone Aren’t Enough to Support Healthy Brain Development

Study Looks at Preventing Stunted Brains, Not Just Stunted Growth

By Amy Quinton on September 16, 2019 in Human & Animal Health

A new study led by researchers at the University of California, Davis, shows that caregiving programs are five times more effective than nutrition programs in supporting smarter, not just taller, children in low- and middle-income countries.

The research, published in the journal The Lancet Global Health, examined 75 early intervention programs and their effects on children’s growth and brain development. Researchers have known adequate nutrition during pregnancy and childhood improve both conditions. But children growing up in poverty face a variety of risk factors that could govern growth and development differently.

“Our study found that we can’t just focus on nutrition. Other aspects of nurturing care are just as, if not more important in supporting healthy brains,” said lead author Elizabeth Prado, assistant professor of nutrition at UC Davis.

Prado says interventions that promote caregiving and learning, such as parents playing games, singing songs and telling stories with their children, have far bigger effects on children’s cognitive skills, language skills and motor development.

“We knew that nurturing care was important but were struck by how big its benefits were compared to nutrition and growth,” added Leila Larson, a lead collaborator from the University of Melbourne.

Investing in caregiving and learning

Global health programs typically focus on preventing stunting, when children are not growing in height the way they should for their age. Stunted growth has also been associated with lower than average school achievement and cognitive scores.

“The association has been influential in prioritizing a global agenda to promote nutrition and growth,” said senior author Anuraj Shankar, with the Center for Tropical Medicine and Global Health at Oxford University. “However, our true goal isn’t just for children to grow taller but for them to fulfill their developmental potential. The study shows that won’t happen unless we target caregiving to nurture thriving individuals and communities.”

Globally, an estimated 156 million children younger than 5 years have stunted growth and an estimated 250 million are at risk of not fulfilling their developmental potential.

Media contact(s)

Elizabeth Prado, UC Davis Department of Nutrition, 301-697-9542,

Amy Quinton, UC Davis News and Media Relations, 530-752-9843, cell 530-601-8077,

Karen Nikos-Rose, UC Davis News and Media Relations, 530-219-5472,

Anuraj Shankar, Center for Tropical Medicine and Global Health, Oxford University, 617-955-6724,

New TRELLIS Lab findings published in Jan/Feb, 2019

Two new papers from the TRELLIS lab have been published early this year in the American Journal of Clinical Nutrition and the BMJ Global Health.

In the American Journal of Clinical Nutrition, Ocansey and colleagues report that lipid-based nutrient supplements (LNS) provided to pregnant women and their children from 0-18 months in Ghana reduced social-emotional problems 5 years later, compared to groups who received only micronutrients. Children with lower home environment scores showed the greatest benefits of LNS, suggesting that early nutritional supplementation buffered the effect of a poor home environment on the development of behavioral problems. This study is the first long-term follow-up of a randomized controlled trial of both prenatal and postnatal LNS supplementation, and suggests that such supplementation may be part of an effective strategy to prevent the development of behavioral problems.

In the BMJ Global Health, Prado and colleagues reported factors that contribute to linear growth faltering in 4 longitudinal cohorts of young children, totaling more than 4000, in Ghana, Malawi, and Burkina Faso. We found consistent associations of 18-mo LAZ with maternal height and maternal body mass index (BMI) in 3-4 cohorts. The factors with the strongest associations with 18-mo LAZ were length for gestational age z-score at birth, maternal height, and gestational age at birth. Other factors that showed significant associations with 18-mo LAZ in 2 cohorts, though with smaller coefficients, were improved household water source, child dietary diversity, childhood diarrhea incidence, and 6 or 9-mo hemoglobin concentration. Interventions targeting these factors associated with LAZ may accelerate progress toward reducing stunting, however, much of the variance in linear growth status remained unaccounted for by individual-level factors suggesting that community-level changes may be needed to achieve substantial progress and further research is needed to understand the causes of stunting.

Symposium on Linear Growth and Neurodevelopment Programmed for Nutrition 2018

Nutrition 2018

Sunday, June 10, Hynes Convention Center, Ballroom C

Full Schedule

An estimated 155 million children are stunted and stunted growth is consistently associated with delayed cognitive development. This strong and consistent association has led to the widespread use of stunted growth as an indicator of delayed neurodevelopment. Interventions that decrease stunting are assumed to improve neurodevelopment. Likewise, it is commonly assumed that a country’s progress in reducing stunting will correspond to improving children’s brain development. These assumptions are only valid if the same underlying factors cause both linear growth failure and delayed neurodevelopment. An alternative possibility is that linear growth and neurodevelopment are constrained by different co-occurring environmental risk factors. If this is the case, then reducing the prevalence of stunting through an intervention or through a country’s progress over time may not correspond to improvements in children’s neurodevelopment. The goal of this symposium is to present novel evidence to test these two contrasting possibilities. With new analyses of large longitudinal cohort studies and meta-analyses, the presentations will address extent to which the determinants of linear growth faltering and delayed neurodevelopment are independent versus shared, and compare the effects of various types of interventions on each outcome.

Prado presents at the UC Davis Nutrition Update Symposium

Dr. Prado recently presented at the UC Davis Nutrition Update Symposium held at Putah Creek Lodge. This two-day symposium brought together UC Davis Nutrition Department faculty and UC Cooperative Extension professionals from UC ANR, UC CalFresh, and members from the Center for Nutrition in Schools.  The symposium was a valuable opportunity to strengthen the collaborations between the Department of Nutrition, associated units and schools, and UC Cooperative Extension throughout the state. Attendees of the symposium underscored the importance of continual and future partnerships to coordinate campus-based and county-based research with nutrition and health programs delivered throughout the state of California.   Dr. Prado presented on the “Effects of Dietary and Caregiving Interventions during Early Life on Child Development.”


Prado and colleagues examine associations between maternal nutrition, maternal cognition, and caregiving in Malawi

Many pregnant women, especially first-time mothers, spend time learning new information about how to care for themselves during pregnancy and planning for caring for their newborn child. After giving  birth, mothers are constantly trying to figure out the puzzle of what their infant is trying to communicate to them and how they can best care for their babies’ needs. Mothers need optimal cognitive performance, such as the ability to focus and pay attention, memory, and reasoning to do this well, and adequate nutrient intake is necessary for the brain to perform these skills. Women require higher amounts of vitamins, minerals, and other nutrients in their diet during pregnancy and postpartum, and many women are at risk for nutrient deficiencies during these periods. Very few studies have examined whether nutrient deficiency might impair maternal cognition and caregiving.

In a randomized trial in Malawi, Prado and colleagues measured differences in cognitive performance and caregiving behavior between women who had received three different types of nutritional supplements over a one-year period from early pregnancy through six months postpartum.  They found that women who received multiple micronutrients or lipid‐based nutrient supplements, compared to iron and folic acid, did not have higher scores in attention, executive function, reasoning, functional health literacy, or  caregiving behavior, as measured in this study. However, in some subgroups of women with baseline low hemoglobin, poor iron status, or malaria women who received lipid-based nutrient supplements scored higher in executive function. Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were associated with attention and executive function, suggesting that these may be key nutrients to optimize cognitive function in postpartum women.


Prado EL, Ashorn U, Phuka J, Maleta K, Sadalaki J, Oaks BM, Haskell M, Allen LH, Vosti Steve A, Dewey KG. Associations of maternal nutrition during pregnancy and post-partum with maternal cognition and caregiving. Maternal & Child Nutrition. 2 NOV 2017, DOI: 10.1111/mcn.12546

Read the Article

Ocansey awarded the Society for Research in Child Development Patrice L Engle dissertation grant for global early child development

The Patrice L. Engle Dissertation Grant provides support for students interested in a career in global early child development who are from or doing research in low- or middle-income countries. Eugenia Maku Ocansey was awarded this grant for her dissertation project “Assessing developmental outcomes at preschool age following three micronutrient supplementation strategies for pregnant and lactating women and their infants in Ghana.”

While adequate nutrition is necessary for the rapid brain development that occurs during gestation and the first 2 years of life (the first 1000 days), and many pregnant women and children across the globe are at risk for nutrient deficiencies during this period, few randomized controlled trials of nutritional supplementation during both pre- and post-natal periods have assessed long-term cognitive development. For her dissertation research, Ocansey is leading the developmental assessments in the pre-school follow-up study of the International Lipid-Based Nutrient Supplements (iLiNS) Project DYAD trial in Ghana, which provided lipid-based nutrient supplements to women during pregnancy and their children from six to 18 months. This project will enable the examination of long-term cognitive effects of supplementation with micronutrients, protein, and fatty acids during most of the first 1000 days.





Prado lead author on paper identifying six key factors that predict early child development

As countries mobilize to reach Sustainable Development Goal 4.2, to ensure “access to quality early childhood development” (ECD), evidence is needed to inform the design of interventions. Previous reviews have identified 44 risk factors for poor ECD in low- and middle-income countries. Which of these factors are most important for strategic targeting to maximize the likelihood of making a difference?

Prado and collaborators on the International Lipid-Based Nutrient Supplements (iLiNS) Project had a unique opportunity to answer this question in the most comprehensive dataset that has examined this question to date. In four cohorts totaling 4205 children in Malawi, Ghana, and Burkina Faso, data were available on 22 of the 44 risk factors identified in previous reviews, plus 12 additional factors likely to be associated with ECD.

Six factors were consistently associated with language and/or motor development at age 18 months in 3 or 4 cohorts: children’s variety of play materials, activities with caregivers, dietary diversity, linear and ponderal growth, and hemoglobin/iron status. These are likely to be key factors for targeted interventions to enhance child development. Among factors that were only measured in one or two cohorts, factors that were associated with language development were maternal cognition, 6-mo home stimulation, and frequency of child feeding, while factors that were associated with motor development were maternal health literacy, maternal and child basal cortisol, 18-mo inflammation, and 18-mo physical activity, suggesting that these are important factors for further research.

At age 18 months, children from low socio-economic status (SES) households had fallen behind those from higher-SES households in language development in all four cohorts and in motor development in two cohorts, highlighting the importance of child development interventions targeting this early period. Associations between SES and language development were largely mediated by caregiving practices rather than maternal or child bio-medical conditions, suggesting that interventions to reduce socioeconomic disparities in child development should target caregiving behavior.


Prado, E. L., Abbeddou, S., Adu-Afarwuah, S., Arimond, M., Ashorn, P., Ashorn, U., Bendabenda, J., Brown, K. H., Hess, S. Y., Kortekangas, E., Lartey, A., Maleta, K., Oaks, B., Ocansey, E., Okronipa, H., Ouédraogo, J. B., Pulakka, A., Somé, J., Stewart, C., Stewart, R., Vosti, S. A., Yakes Jimenez, E., Dewey, K. G. (2017). Predictors and pathways of language and motor development in four large prospective cohorts of young children in Ghana, Malawi, and Burkina Faso. Journal of Child Psychology and Psychiatry. (Epub ahead of print).

« Older posts

© 2020 Trellis Lab

Theme by Anders NorenUp ↑